No power for the people

Iona Heath, writing in the British Medical Journal BMJ 2009;339:b3735 described the failure of Camden PCT to hold a meaningful consultation process,

This consultation is a travesty and provides a close and dispiriting encounter with the realities of accountability and transparency in today’s NHS. It begins by inviting agreement with a series of very broad local health priorities, which include reducing health inequalities and improving mental health services. It then asks: “Do you support our plan to expand primary health care in Camden through our polyclinic programme?” It offers no alternative policies and goes straight on to ask: “Which services should go into our local polyclinics?” This is not consultation, it is manipulation. A later question asks “Do you support the development of a range of services at the new GP led health centre?” but fails to mention that the services have already been tendered. There has been no attempt to survey public opinion or the views of health professionals working in Camden in a way that could be considered statistically valid or defensible. The powerlessness of ordinary people to affect local policy in the unfortunate English part of the NHS is profoundly depressing.

In Hackney, with other members of Keep Our NHS Public I’ve spoken at public meetings and stood in the streets handing out leaflets and answering questions. We’ve been doing the work of the PCT, informing people that the PCT have been forced by the Department of Health to offer private corporations the opportunity to run NHS services including GP led health centres, walk-in centres and diagnostic services. People are usually shocked and respond by saying that the government would never do this, and if they tried it would be all over the news. A tiny minority of people say that they don’t care what happens. No-one, ever has said that they had heard about what was going on as a result of a PCT consultation. Even people we’ve spoken to who’ve responded to consultations deny being informed that NHS services were being offered to private companies.

The lack of democratic process and lack of regard for public opinion cannot be explained by the genuine difficulty of holding a comprehensive consultation. Iona Heath goes on:

As soon as you begin to question where the real power lies, you discover what could be a quagmire of real or potential conflicting interests. In June, Mark Britnell, the NHS’s director general for commissioning and system management, who has been instrumental in opening up the NHS to for-profit companies and the driving force behind “world class commissioning,” left the NHS to join the private company KPMG. Britnell also created the “framework for securing external support for commissioners” (FESC). On its website UnitedHealth UK proudly declares that, under FESC, it is “a preferred supplier by the Department of Health to support Primary Care Trust commissioning capabilities,” while it is, at the same time, applying to provide commissioned services. Mark Hunt, the managing director of primary care services for Care UK, was previously responsible for designing policy in the strategy unit of the health department. These are just two of the ever growing number of civil servants and politicians leaving the department to take up lucrative positions with the private companies that are profiting from the policies they have helped to create.

As disastrous as I believe a market driven NHS will be, as a citizen I consent to democracy.

I have written to my MP on several occasions and spoken at the House of Commons. The extraordinary response of my own MP, Meg Hillier and from Ben Bradshaw (last year) was to bluntly deny that there is any process of NHS privatisation.

If the process of forcing markets into the NHS is not democratic and the democratic avenues are closed with bare-faced lies and flat denials, then the question arises, how should one proceed?

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